Q. How are premiums determined?
A. OMIC charges those premiums determined necessary to cover current and
anticipated policyholder losses and to maintain financial stability. Independent
actuaries evaluate OMIC's actual loss experience data and the loss experience
data for ophthalmology from other carriers throughout the nation and calculate
recommended premiums for ophthalmologists by scope of practice and location accordingly.
These recommendations are then reviewed and voted upon by our Board of Directors,
which is made up of practicing ophthalmologists.
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Q. Can I estimate my premium by using the rate chart?
A. Yes. However, your actual premium may be different, depending
on your eligibility for discounts or your performance of higher rated procedures
such as cosmetic full facelifts or liposuction. The chart reflects annual
premiums and is broken down by scope of practice and limits of liability for
each step of the step-rating process. To calculate your approximate premium,
first find your appropriate step-year by totaling the number of years you have
continuously been insured under a claims made policy; and then add one year. Next,
find your class in the left-hand column. Classes are determined by scope
of practice (no surgery or surgery class 1, 2 or 3). Then, move across
the chart to the appropriate column for your desired liability limits. This is
the premium you will most likely pay. Special rating may apply if you are requesting
prior acts coverage for services rendered in a higher-rated territory or coverage
class than the class and territory that apply to your current practice activities.
If you have been insured under a claims made policy for at least four full
years, you will be rated at the "mature" step listed on the last
row of the rate sheet. Most applicants with an established practice will
already be at a "mature" (fifth year) step. If you are currently
insured under an occurrence policy, you will not need prior acts coverage from
OMIC and would look at the premiums noted in the "claims made year 1" section
of the rate chart.
OMIC will provide you with a quotation for the actual cost after we have reviewed
and approved your completed application, although we will be happy to provide
you with an estimate at any time.
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Q.What if I have been in practice five years but have been previously insured on a claims made and reported basis for only three years?
A. If your prior insurance carrier has been providing you with claims made and reported coverage for three years, you would look at the premiums noted in the "claims made and reported year 4" section. If you are uncertain as to which claims made and reported step would apply to you, please call us. We will need your retroactive date (found on your declarations page) to advise you, so please have it handy.
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Q. What if I practice in more than one state or territory?
A.Your rating territory will be determined by your percentage of practice
in the higher rated territory. Percentage of practice is based on percentage
of practice hours or percentage of income, whichever is greater. If you
practice 20% or more in the higher rated territory, your premium will be based
on that territory’s rates. If, however, you practice there less than
20%, the lower rated territory’s premium will apply.
Please note that OMIC will be unable to provide coverage to you if you practice
more than 25% in a state in which we do not write insurance. Currently,
OMIC writes insurance for ophthalmologists in all states except Wisconsin; however,
we continue to work with the regulators in that state in an effort to make OMIC
coverage available to all U.S. Academy members.
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Q. If I’m in a Patient Compensation or Excess Liability Fund state,
can I buy OMIC coverage and still participate in the benefits of the PCF?
A. In New Mexico, physicians must be insured on an occurrence basis (which
OMIC does not offer) to be eligible for participation in the PCF. In all
other states where OMIC offers coverage, our insureds may participate, and many
do. In some states, participation in the PCF is mandatory, while in others it
is optional. Please contact us to determine which rules apply to you.
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Q. Will my premium be based on the types of procedures I perform?
A. Yes. To make your premiums more flexible and affordable, OMIC offers four different coverage classes and rates, each based on its risk relativity:
Ophthalmology - No Surgery includes coverage only for non-surgical activities. Covered activities include the diagnosis and non-surgical treatment of diseases (other than screening for or treating retinopathy of prematurity), prescription of glasses or contacts, mechanical epilation, punctal closure with plugs, and removal of superficial foreign bodies from the cornea and conjunctiva. The No Surgery premium is approximately 10% lower than the Surgery Class 1 premium.
Ophthalmology - Surgery Class 1 applies to physicians who have reduced the scope of their surgical activities to minimally invasive procedures. This class includes coverage for non-surgical ophthalmology (other than screening for or treating retinopathy of prematurity) as defined above and the following surgical procedures: removal of sutures, fluorescein angiography, tear duct probing or irrigation done under local anesthetic, repair of minor lid lacerations limited to the skin and/or muscle, repair of minor conjunctival lacerations, biopsy of lid tumors, biopsy of the conjunctiva, removal of cysts and other non-cancerous skin lesions and tumors, removal of corneal epithelium, incision and drainage, implantation of eye jewelry, laser hair removal, photo-epilation, hair removal using radio frequency/light energies, subconjunctival injections, intramuscular injections, intravenous injections, injection of Botox or collagen and other fillers, stromal puncture, micropigmentation, microdermabrasion, superficial chemical peels limited to the epidermis, removal of papillomas and chalazions, electrical epilation, cryotherapy of the lid, and non-incisional entropion or ectropion repair. The Surgery Class 1 premium is approximately 40% of the Surgery Class 3 rate.
Ophthalmology - Surgery Class 2 applies to physicians who have reduced their surgical practice to specified procedures. Surgery Class 2 includes coverage for non-surgical ophthalmology (other than screening for or treating retinopathy of prematurity) and Surgery Class 1 procedures as defined above, assisting in surgery, and the following additional surgical procedures: laser capsulotomy, laser iridotomy, laser iridoplasty, laser punctal closure, punctal closure with cautery, laser trabeculoplasty, wedge resection for suspected non-cancerous tumors, suture tarsorrhaphy, marginal adhesion tarsorrhaphy without incision into the tarsus, laser ablation of corneal lesions, temporal artery biopsy, blue light acne treatment (with or without photodynamic therapy), non-invasive cellulite reduction, skin rejuvenation/tightening using non-invasive, non-ablative techniques, periocular injections, periorbital injections, peribulbar injections, retrobulbar injections, and sub-Tenons injections. This class is rated at approximately 75% of the Surgery Class 3 premium.
Ophthalmology - Surgery Class 3 insures physicians for the full scope of standard surgical ophthalmology. This class includes coverage for non-surgical ophthalmology, assisting in surgery, and all surgical procedures considered ordinary and customary for the practice of ophthalmology, including screening for or treating retinopathy of prematurity. Coverage of refractive surgery is subject to underwriting review and endorsement. Coverage of full facelifts for cosmetic purposes, liposuction, and rhinoplasty are subject to underwriting review, endorsement, and payment of additional premium.
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Q. Does OMIC offer a part-time discount? *
A. OMIC offers a premium discount to qualified physicians who limit their
scope of practice to No Surgery, Surgery Class 1, or Surgery Class 2 procedures: 50%
for those who practice less than 20 hours per week and 65% for those who
practice less than 10 hours per week. Surgery Class 3 physicians who practice
less than 20 hours per week and perform fewer than 100 surgeries annually may
qualify for a 25% discount.
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Q.Does OMIC offer discounts to new doctors? *
A. To meet the needs of new doctors, OMIC has implemented a special discount
program for physicians who are in their first, second, third, or fourth year
of practice following completion of residency, fellowship, or military service.
Discounts of 75%, 50%, 25%, and 10% apply respectively. If you have just completed
residency, you will join OMIC with the first year new doctor discount of 75%.
A 50% reduction will apply during your second year of practice, a 25% reduction
will apply in your third year, and a 10% reduction will apply in your fourth
year. This discount is in addition to the reduced premium that applies based
on your step rate.
If you completed training within the past four years but have been insured elsewhere for the early years of practice, you will join OMIC at a discount based on your number of years in practice. For example, if you have been in practice 18 months at the time you join OMIC, you will receive a 50% discount for the first 6 months of OMIC coverage, a 25% discount the next 12 months, and a 10% discount the following 12 months.
If you feel you may be eligible for our new doctor discounts, please call us so we can advise you which discount will apply.
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Q. If I'm new to OMIC, do I get the new doctor discount?
A. Only if you are in your first, second, third, or fourth year of practice as explained above. This discount is reserved for physicians entering practice for the first time. Even if you don't qualify for the new doctor discount, you will be rated at the lower first year step-rate if you were insured under an occurrence policy immediately prior to joining OMIC or if you purchase "tail" coverage from your prior claims made and reported carrier.
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Q. What other discounts are available? *
A. OMIC offers three other discount programs to its members: a risk management
discount, a loss free credit, and a group discount.
(1) OMIC offers a 5% risk management discount to physicians who have participated
in an OMIC-sponsored risk management program within the 12 months prior to their
policy effective date. OMIC provides many opportunities for physicians
to qualify for this discount, including risk
management seminars, live audio
conferences, recorded audio programs available on CD, and online
courses. As
a general rule, only one risk management discount can be applied per policy period.
Members
of participating state or subspecialty ophthalmic societies having a special
cooperative relationship with OMIC may qualify for a supplemental risk management
discount by participating in a jointly sponsored risk management activity.
(2) OMIC also offers a loss free credit for physicians who have been insured for at least two years without any indemnity payments. Pending claims or claims that close without indemnity do not affect your eligibility for this discount. Discounts range from 3% to 5%, depending on the number of years you are insured without a loss.
(3) Group discounts may be extended to qualified groups of 3 or more physicians.
The amount of the discount is based upon the group's size, risk management
participation, and favorable loss experience, among other factors.
Risk management, loss free, and group discounts can apply concurrently, and
the combination of discounts could significantly reduce your insurance premiums.
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Q.What risk management seminars qualify me for a discount?
A. Because of the specialized ophthalmic content of our programs, only OMIC-sponsored risk management programs qualify towards the risk management discount
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Q. Do I have to pay my annual premium in full when I join?
A. No. To help ease financial burdens, OMIC has set up a quarterly
installment plan for premium payments. A modest service charge is assessed for
this convenience.
Unlike premium payments, premium taxes and Patient Compensation/Excess Liability
Fund assessments, if applicable, must be paid in full at policy issuance.
For your convenience, OMIC has enabled online
payment by Visa or MasterCard.”
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Q. Do I have to pay a capital contribution or surplus contribution to join OMIC?
A. No. Although OMIC has the right to require surplus or capital
contributions, the company has not done so since its early days of operation.
The only payment you make is your premium (and applicable installment charge
if you elect to pay on a quarterly basis). State-mandated premium
taxes and Patient Compensation/Excess Liability Fund fees may also apply, depending
upon your state of practice.
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Q. Can OMIC ever assess me for additional premium?
A.No, OMIC’s policy is non-assessable. Although changes in
your practice location, scope of practice, or liability limits may affect your
premium, under no circumstance can OMIC collect more money from you to recoup
losses and expenses that exceed the initial premium charged to you for a policy
period.
However, if you are a physician licensed and practicing in Massachusetts, your
state may collect from you any and all state-ordered assessments as a condition
of your medical licensure. Similarly, New Hampshire physicians who were
previously insured by the state's Joint Underwriting Association may be responsible
for state-ordered assessments. If a state orders an "assessment," such
assessments generally apply to all practicing physicians, regardless of their
insurance carrier.
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Q. Does OMIC pay dividends?
A.No carrier can guarantee the availability of dividends. OMIC distributed policyholder dividends annually from 1991 through 2002 but temporarily suspended the dividend program from 2003 through 2005 in response to unfavorable market conditions. After market conditions improved, OMIC was able to once again declare annual dividends. The company’s ability to apply future dividends is contingent upon our favorable financial condition. When declared, dividends are based on a percentage of premium and are applied as a credit toward the insured's renewal premium.
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